Arresting Sepsis Early Saves Money, Lives

Some hospitals are addressing sepsis by quickly identifying high-risk patients in the emergency department and treating them to stop progression.

This article appears in the June 2014 issue of HealthLeaders magazine.

Sepsis, which can lead to severe organ failure and shock, is a leading if not the biggest cause of hospital mortality. This insidious, under-recognized consequence of infection sickens as many as 1.1 million people in the United States each year. The mortality rate for sepsis is estimated to be between 28% and 50%.

It also is an expensive disease to treat in a hospital, with healthcare costs estimated at $17 billion a year in the United States, in part because half of sepsis patients require an intensive care unit stay. Many who survive its later stages endure impaired physical and mental function, and thus a deteriorated quality of life that costs the healthcare system even more.

But now, better protocols and greater penalties against hospitals with higher mortality rates have prompted bold and successful efforts to stop sepsis in older people at higher risk, as well as young children and adults. These days, some hospitals are leading the way to quickly identify high-risk sepsis patients in the emergency department and treat them to stop progression, and get it all done within the first three or six hours.

Some 16 states now have a sepsis law or regulation governing protocols or reporting, and a 17th, Massachusetts, is considering one in its state Senate.

At the federal level, the Centers for Medicare & Medicaid Services last year signaled its intention to add a "severe sepsis and septic shock management bundle" to its EHR Hospital Inpatient Quality Reporting program, which could take effect as early as next year. If that happens, it will serve as another financial incentive to push sepsis prevention, for hospitals already are penalized for higher 30-day mortality rates, driven all the higher by so many sepsis patient deaths.

So it stands to reason that acute care providers, especially big ones like 17-hospital North Shore-LIJ Health System in New York City, Northern California's 21-hospital Kaiser Permanente, and the 42-hospital Carolinas HealthCare System in North Carolina, South Carolina, and Georgia, would be rushing to find better ways to deal with sepsis.

They want to recognize sepsis when patients first appear with symptoms in the emergency department, and thwart it before it causes organ dysfunction and shock.

That's what prompted NS-LIJ President and CEO Michael Dowling and his team to make sepsis a top priority, and get mortality rates way down. It's been a five-year journey but, Dowling says, they've made tremendous progress.